Pine Ridge Dental, Pllc

NPI #1881404564 in Longmont, Colorado

Provider Information

NPI Number: 1881404564
Entity Type: Organization
Organization Name: Pine Ridge Dental, Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 13, 2025
Last Updated: Jan 13, 2025

Practice Location

Address: 541 MAIN ST
City: Longmont
State: Colorado
ZIP Code: 80501-5536
Phone: (303) 776-0312

Authorized Official

Name: NICK SUNDIAM
Title: CREDENTIALING MANAGER
Phone: (719) 300-5933

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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